EVENING. Health. HEALTH LINE. Letters.

Q. My husband was diagnosed with chronic pancreatitis and...

December 20, 1999|By Dr. Allen J. Douma.

Q. My husband was diagnosed with chronic pancreatitis and gastroparesis. I am having a difficult time finding information on these diseases. Can you help? Also, could you suggest any ways I might be able to create a support group?

A. If the recurring pain and other symptoms of pancreatitis weren't enough, your husband's double diagnosis must seem like things are piling up to you both.

The pancreas secretes fluids into the intestine to help food digestion and secretes sodium bicarbonate to neutralize stomach acid. In addition, it secretes insulin and glucagon directly into the bloodstream to control sugar metabolism.

Up to 20 percent of the time, the cause of pancreatitis is unknown. A less common form of chronic pancreatic inflammation is known as autoimmune chronic pancreatitis.

In the more common form, obstruction and inflammation of the duct from the pancreas to the small intestine prevent the flow of secretions and can lead to destruction of functioning pancreatic tissue.

Seventy to 80 percent of obstructive chronic pancreatitis is caused by alcoholism, but the condition can be caused by anything that blocks the pancreatic duct. There may be an inherited predisposition to the disease.

Obstructive chronic pancreatitis is characterized by mild to severe continuing or episodic abdominal pain. Major complications include narcotic addiction (as the result of treatment), diabetes and malnutrition. The disease is strongly suspected from symptoms (abdominal pain, anorexia, constipation, nausea and vomiting, flatulence and weight loss) and the diagnosis is confirmed by lab studies and radiological imaging.

Treatment consists of addressing three factors. First, controlling underlying causes or contributing factors, e.g., strict adherence to a diet avoiding alcohol and high fat and protein foods, or surgical removal of any obstruction of the pancreatic duct.

Next is to replace the secretions not produced from the damaged pancreas: antacids and pancreatic enzymes, plus insulin if indicated. The final part of treatment involves control of pain, including narcotic analgesics and even surgery.

In gastroparesis, the stomach takes too long to empty its contents, which occurs when the vagus nerve that controls muscles that propel food through the digestive tract is damaged. Diabetes is the most common cause of gastroparesis due to vagus nerve damage. Other causes include stomach or vagus nerve surgery, viral infection, anorexia, some drugs and disorders of the smooth muscles or nervous system.

Gastroparesis can also occur without nerve damage, e.g., physical blockage of the outlet from the stomach to the small intestine. Blockage can occur as a result of the inflammation and swelling associated with pancreatitis

People with gastroparesis are advised to avoid fat and high-fiber foods, and to eat several small meals instead of three large ones. Liquid meals pass through the stomach easier.

The combination of pancreatitis and gastroparesis obviously puts a double burden on the digestive system. But if your husband's gastroparesis is the result of his pancreatitis, he may only need to treat one disease.

I suggest you ask his doctor or a discharge planner at a local hospital. Also, many health Web sites such as allhealth.com have national support groups for almost any type of disease.